Our goals is to provide you with Timely care. We believe in Urgent treatment of
cancer so that patient’s disease has no chance to continue to grow. Cancer has best
chance of cure if treated as soon as diagnosed. Otherwise cancer becomes incurable
while patient is waiting to get started with treatment.

Mission

Our mission is to provide you with timely, high quality and reliable cancer care
and to help support you and your family in your fight against cancer.

Our Team

Dr Muhammad Arif is head of Medical Oncology and Hematology at Doctors Hospital,
Lahore and Visiting Consultant Oncologist and Hematologist at Ittefaq Hospital,
Lahore.

Dr Arif did his postgraduate training in USA. He did his Internal medicine training
from Harlem Hospital, Columbia University, NY, USA. He then proceeded to do further
specialization in Cancer and blood diseases. He did his Oncology and Hematology
Training and Fellowship from Bay state Medical Center western Campus of Tufts University
Massachusetts, USA. He did his Diplomat American Boards in Medicine, Medical Oncology
and Hematology.

Dr Arif has over 15 years of practice experience in United States. He also has worked
at Shaukat Khanum Memorial Cancer Hospital Lahore from 2005-2007.

Dr Arif has vast clinical experience in diagnosing and treatment of all kinds of
cancer and blood diseases. He treats patients at newly built Cancer Center at Doctors
Hospital. This is state of the art cancer center with 14 infusion suites for chemotherapy.
Our staff is fully trained in preparation and administration of chemotherapy. We
have chemotherapy trained nurses and pharmacist. Our chemotherapy is prepared in
specially built drug preparation hood as per international safety standards.

Our Services

We provide full range of Medical Oncology and Clinical Hematology services for Adult
s and Children. Our Consultants are American Trained and certified Medical Oncologist
and Clinical Hematologist for both adults and kids. They have vast experience of
diagnosing and treating cancers and blood disorders. We provide following services
at Doctors Hospital Cancer Center:

Diagnosis and Treatment of HIGH Blood counts like high HB, High WBC or high Platelets.

Diagnosis and Treatment of Blood clotting disorders.

Diagnosis and Treatment of Bleeding Disorders.

Chemotherapy and Immunotherapy and Biological Therapy.

Treatment of Cancer related Symptoms (Palliative care).

Treatment of Cancer related Pain.

Transfusion support services.

24/7 around the clock Phone help for patients.

Cancer Screening services to diagnose and treat cancer before the Symptoms arise.

STEM CELL Transplant in near Future. If you have any questions, please feel free
to contact us at 0323-918-6000/ 0310-458-6667.

Clinical hematology

We Specialize in Diagnosis and treatment of all blood disorders including low and
high counts, Aplastic anemia, MDS, bleeding/clotting etc. , Leukemia ( Cancers of
Blood) ,Lymphomas( cancers of Lymph glands and system) and Myeloma ( Cancer of Plasma
cells in bone marrow).

Blood Basics

Blood is a specialized body fluid. It has four main components: plasma, red blood
cells, white blood cells, and platelets. Blood has many different functions, including:

Transporting oxygen and nutrients to the lungs and tissues

Forming blood clots to prevent excess blood loss

Carrying cells and antibodies that fight infection

Bringing waste products to the kidneys and liver, which
filter and clean the blood

Regulating body temperature

The blood that runs through the veins, arteries, and capillaries is known as whole
blood, a mixture of about 55 percent plasma and 45 percent blood cells. About 7
to 8 percent of your total body weight is blood. An average-sized man has about
12 pints of blood in his body, and an average-sized woman has about 9 pints.

Blood Disorders

When something is wrong with your blood, it can affect your total health. That is
why it is important for you to know about some of the common blood disorders that
may affect you.

It may be that blood is being lost from the body like
bleeding in stool, urine or, in women, heavy menstrual bleeding.

It may be that your bone marrow is not producing enough
due to certain disease or low nutrients like vitamins or iron.

It may be that your blood is being broken down due to
immune problems, drugs etc. Depending on the cause, then the treatment is done.

B - HIGH HEMOGLOBIN……Polycythemia

When you have more blood in the body than you need, it’s called Polycythemia. It
is mainly from bone marrow problems. Rarely it may be secondary to smoking. Various
tests are done to find out the cause and treated accordingly.

C - LOW WBC COUNT………Leucopenia

Leucopenia means low white blood cells. White blood cells help defend the body from
infections. There are five different kinds of white blood cells. Leucopenia is serious
condition and REQUIRES URGENT DIAGNOSIS and treatment.

D - HIGH WBC COUNT………Leucocytosis

High white count could be a sign of infection, smoking, Leukemia (blood cancer).Depending
on the cause; it may be benign or Cancerous. It requires URGENT DIAGNOSIS and treatment.

E - LOW PLATLET COUNTS…Thrombocytopenia

It means low platelet count. Platelets may be low because of immune problems (ITP)
,Drugs , Infections (Hepatitis) .These may be low because of infection, bone marrow
problems like leukemia. Low platelet count can be very dangerous and cause bleeding.
It needs to be diagnosed and treated URGENTLY.

F - HIGH PLATLET COUNT…Thrombocytosis

High platelet count may be because of infection, iron deficiency or serious bone
marrow problems like Leukemia ( Blood cancer ) or similar other bone marrow diseases.
It can be very dangerous and needs urgent treatment.

G - THALASSEMIA

Thalassemia is Very common Blood disease in Pakistan. There are two Main Types:

Beta - Thalassemia

Alpha - Thalassemias

Symptoms can include; Anemia…Low hemoglobin (low Hb)

Bone deformities in the face

Fatigue

Growth failure

Shortness of breath

Spleenomegally

Diagnosis

A physical exam may reveal a swollen (enlarged) spleen.

Blood test:

Red blood cells will appear small and abnormally shaped
when looked at under a microscope.

A complete blood count (CBC) reveals anemia.

A test called hemoglobin electrophoresis shows the presence
of an abnormal form of hemoglobin

Treatment

Treatment for thalassemia major often involves regular
blood transfusions and folate supplements.

If you receive blood transfusions, you should not take
iron supplements. Doing so can cause a high amount of iron to build up in the body,
which can be harmful.

Persons who receive significant numbers of blood transfusions
need a treatment called chelation therapy to remove excess iron from the body.

Bone marrow transplant may help treat the disease in
some patients, especially children.

Prevention is the KEY

All young people should be tested before the marriage and counseled if they have
thalassemia Risk to pass on to the future generations.

For any questions, please call 092-323 918 6000

H - Von Willebrand Disease

Von Willebrand Disease (VWD) is the most common hereditary bleeding disorder in,
with an estimated prevalence ranging upward to 1% of the general population. Males
and females are both approximately equally affected. VWD arises from a deficiency
or dysfunction of von Willebrand factor (VWF).

TYPES

There are three main variants of the disease.

Type 1 VWD is a partial quantitative deficiency of normally
functioning VWF. It is the most common variant, accounting for approximately 75%
of symptomatic individuals, and is generally associated with mild bleeding symptoms.
Type 2 VWD is a qualitative deficiency due to abnormal function of VWF. It accounts
for nearly all the remaining affected individuals

Type 2 has further subtypes including 2A, 2B, 2M, and
2N. These subtypes are characterized by where the abnormal function occurs within
the VWF. Of the subtypes, 2A is the most common.

Type 3 VWD is the rarest of the variants and is estimated
to only affect 1 in 1,000,000 individuals. It arises from the virtual absence of
VWF protein and can be associated with severe bleeding symptoms.

MANAGEMENT OF VWD

We use medications to increase plasma level of VWF and factor 8. We sometimes use
plasma transfusion and factors to increase levels. Medications are used to decrease
the risk of bleeding. Specific of management of VWD with AVWS, menorrhagia, hemorrhagic
ovarian cysts, pregnancy and childbirth IS ALSO NEEDED UNDER EXPERT SUPERVISION.

I - Bleeding Disorders

Bleeding disorders are inherited or temporary and/or acquired. Inherited Disorders
are rare .There is increased or prolonged bleeding due to (the inability of the
blood to clot. The cause is a decrease in amount or function of one of the 11 proteins
in the blood, called clotting factors, that work together to make the blood clot.

NORMAL COAGULATION

There are three stages in normal hemostasis or coagulation (blood making a clot
to stop bleeding).

First, the injured blood vessels constrict to reduce potential loss of blood.Second, the blood platelets attach themselves cells in the wall of the damaged
blood vessel at the site of vessel injury, and platelets then begin to stick to
each other (aggregate), promoting formation of a platelet plug (primary clot).
Finally, plasma clotting proteins are activated in sequence in order to convert
fibrinogen to fibrin to establish a mature clot that contains a stabilizing fibrin
network.

The 11 plasma clotting factors circulate in inactive form until they are converted
in sequential order to fully activated enzymes that can activate the next factor
in the sequence.

There are many Bleeding Disorders and they are treated in different ways depending
on the cause of the bleeding.

Common Bleeding disorders are Von Willebrand Disease, Hemophilia etc.

J - Clotting Disorders

Blood clotting is a process that prevents excessive bleeding when a blood vessel
is injured. Platelets (a type of
blood cell) and proteins in your plasma
(the liquid part of blood) work together to stop the bleeding by forming a clot
over the injury. Typically, your body will naturally dissolve the blood clot after
the injury has healed. Sometimes, however, clots form on the inside of vessels without
an obvious injury or do not dissolve naturally. These situations can be dangerous
and require accurate diagnosis and appropriate treatment.

Clots can occur in veins or arteries, which are vessels that are part of the body's
circulatory system. While both types of vessels help transport blood throughout
the body, they each function differently. Veins are low-pressure vessels that carry
deoxygenated blood away from the body's organs and back to the heart. An abnormal
clot that forms in a vein may restrict the return of blood to the heart and can
result in pain and swelling as the blood gathers behind the clot. Deep vein thrombosis
(DVT) is a type of clot that forms in a major vein of the leg or, less commonly,
in the arms, pelvis, or other large veins in the body. In some cases, a clot in
a vein may detach from its point of origin and travel through the heart to the lungs
where it becomes wedged, preventing adequate blood flow. This is called a pulmonary
(lung) embolism (PE) and can be extremely dangerous.

Common symptoms of Blood clots may be swelling, redness, pain in leg, and change
in color of leg or arm, sudden breathing difficulty, sudden abdominal pain, Jaundice
etc.

PNH is a rare and serious blood disease that causes red blood cells to break apart
called "hemolysis". It happens because blood cells are missing a protein that protects
them from body's immune system.

When red blood cells break apart, the hemoglobin inside them is released. Hemoglobin
is the red part of red blood cells. Its job is to carry oxygen around body. The
release of hemoglobin causes most PNH symptoms. Hemolysis can put a patient at risk
for serious health problems.

A rare disease, the worldwide prevalence of PNH is estimated in the range of 1–5
cases per million, regardless of ethnicity. The disease can affect people of any
age. It may be associated with aplastic anemia, Myelodysplastic syndromes, or acute
myelogenous leukemia.

Where does the name come from?

Here's where the name "paroxysmal nocturnal Hemoglobinuria" comes from:

So, "paroxysmal nocturnal Hemoglobinuria" means sudden, irregular episodes of passing
dark colored urine, especially at night or in the early morning. It is important
to note that many people with PNH do not have dark urine.

PNH Causes

What causes PNH?

PNH occurs because of a change (mutation) in the PIG-A gene of a single stem cell
in the bone marrow. Here are the steps that lead to PNH:

The abnormal stem cell makes copies of or "clones" itself.
This leads to a whole population of stem cells that have mutant PIG-A.

The abnormal stem cells turn into mature red blood cells
that have mutant PIG-A. These are called PNH red blood cells.

The PNH red blood cells lack the shield of proteins that
protect normal red blood cells from the complement system. So they may be attacked
and destroyed by the complement system proteins. Many healthy people have a small
number of stem cells with mutant PIG-A. But in people with PNH, these stem cells
grow fast and make lots of mature PNH red blood cells.

A person's bone marrow may be weakened because they have Aplastic anemia or another
bone marrow failure disease. Weakened bone marrow may also result from a mild bone
marrow disease that was never diagnosed.

PNH Symptoms

What are the symptoms of PNH?
The symptoms you have with PNH are caused by one of the following:

Hemolysis – the breaking apart or destruction of red
blood cells

Thrombosis – blood clots

Low blood cell count – not having enough of a type of
blood cell

PNH Diagnosis

How does my doctor know I have PNH?
PNH is a rare disease. Many doctors have never seen a case of it. So people with
PNH may have symptoms for several years before they get a correct diagnosis.
Test to diagnose PNH is flow cytometry test.
This test is to detect if any proteins were missing from red blood cells. It can
also be done on granulocytes.

PNH is considered chronic. That means it lasts for a long time. The only known cure
is a bone marrow transplant.
Other treatments are designed to ease symptoms and prevent problems.

Blood Transfusions for anemia

Folate and Folic Acid: Folate is a B-vitamin that is
found in fresh or lightly cooked green vegetables. It helps the bone marrow to make
normal blood cells.

Iron as needed.

Prednisone is a steroid that can decrease hemolysis caused
by PNH. It may make the complement system less active. It may also increase counts
of white blood cells and platelets in some people. Prednisone does not stop all
hemolysis, however. And it does have a lot of side effects, especially if taken
for a long time.

Soliris Eculizumab: (Soliris) is the only drug approved
to treat PNH. It works by making complement system less active. ITS GIVEN IV

Bone Marrow Transplantation: If other treatments have
not worked to stop hemolysis, clotting, or bone marrow failure, then a bone marrow
transplant may be the next step.
Bone marrow transplantation is the only way to cure PNH. But it carries many risks,
including death.

L - Aplastic Anemia

Aplastic anemia is a disease of the bone marrow. It happens when the bone marrow
stops making enough red blood cells, white blood cells and platelets for the body.

Aplastic anemia can be moderate, severe or very severe. People with severe or very
severe Aplastic anemia are at risk for life-threatening infections or bleeding.

With prompt and proper care, many people who have Aplastic anemia can be successfully
treated. Many drugs are available which can help cure this and improve blood counts
.Blood and marrow stem cell transplants may offer a cure for some people who have
Aplastic anemia.

What causes Aplastic anemia?
Aplastic anemia is caused by destruction of the blood-forming stem cells in your
bone marrow.
Most research suggests that stem cell destruction occurs because the body's immune
system attacks its own cells by mistake.
So, Aplastic anemia is generally thought to be an autoimmune disease.
About 75 out of 100 cases of acquired Aplastic anemia are idiopathic. This means
they have no known cause.
Hereditary Aplastic anemia -----is passed down through the genes from parent to
child. It is usually diagnosed in childhood and is much less common than acquired
Aplastic anemia. People who develop hereditary Aplastic anemia may have other genetic
or developmental abnormalities.
About 25 out of 100 cases of acquired Aplastic anemia can be linked to one of several
causes.
These include:
Toxins, such as pesticides, arsenic, and benzene
Radiation and chemotherapy used to treat cancer
Treatments for other autoimmune diseases, such as lupus and rheumatoid arthritis
Pregnancy - sometimes, this aplastic anemia improves on its own after the woman
gives birth Infectious diseases, such as hepatitis, Epstein-Barr virus, cytomegalovirus
(si-to-MEG-ah-lo-VI-rus), parvovirus B19, and HIV.
Sometimes, cancer from another part of the body can spread to the bone and cause
Aplastic anemia.

Aplastic Anemia: Treatment

The main goal of Aplastic anemia treatment is to increase the number of healthy
cells in your blood. When your blood counts go up:

You are less likely to need blood from a donor (transfusion)

Your quality of life gets better

Your symptoms are not as bad

Who Needs Treatment

People who have mild or moderate Aplastic anemia may
not need treatment as long as the condition doesn't get worse.

People who have severe Aplastic anemia need medical treatment
right away to prevent complications.

People who have very severe Aplastic anemia need emergency
medical care in a hospital. Very severe Aplastic anemia can be fatal if it's not
treated right away.

Removing a known cause of Aplastic anemia, such as exposure
to a toxin, also may cure the condition.

There are three categories of treatment for Aplastic anemia

Supportive care is a term used for treatments that help
you manage the symptoms of aplastic anemia and is not a cure. This approach includes
the use of:
Blood transfusions
Iron chelation therapy to treat iron overload
Growth factors
Antibiotics

Immunosuppressive drug therapy lowers your body's immune
response. This prevents your immune system from attacking your bone marrow, lets
stem cells grow back, and raises blood counts. In acquired aplastic anemia, immunosuppressive
therapy with anti-thymocyte globulin (ATG) plus cyclosporine is the therapy of choice
for older patients. It is also used for patients who do not have a matched stem
cell donor. About 8 out of 10 patients have a positive response to this treatment.
For patients with severe aplastic anemia (SAA), who have had an insufficient response
to immunosuppressive therapy and who are not candidates for stem cell transplant
Promacta ® (Eltrombopag) is approved for use. Eltrombopag works by helping to increase
production of blood cells.

Stem Cell Transplantation:
A stem cell transplant replaces damaged stem cells with healthy ones from another
person (a donor) Stem cell transplants may cure aplastic anemia in people who can
have this type of treatment. The transplant works best in children and young adults
with severe aplastic anemia who are in good health and who have matched donors.

M - Myelodysplastic Syndromes (MDS)

MDS is a group of disorders where your bone marrow does not work well, and the blood-forming
stem cells in your bone marrow fail to make enough healthy blood cells. People with
MDS can lack the right amount of red blood cells, white blood cells, and platelets
(the small cells that help blood to clot).

The disease happens because the bone marrow cells do not develop into mature blood
cells. Instead, these blood cells stay within the bone marrow in an immature state.
The symptoms and the course of MDS may vary greatly from person to person. These
differences depend on which blood cells are affected.

All people with MDS have two things in common:

They have a low blood cell count for at least 1 blood
cell type. This is called cytopenia.

Their bone marrow and blood contain blood cells with
an abnormal shape, size, or look.

What does the term "Myelodysplastic" actually mean?
Myelo = blood cells and Dysplastic = abnormal development or growth. So, when you
have Myelodysplastic syndrome, this means that your blood cells have an unusual
shape and that they have abnormal growth.

What causes MDS?
Often times, WE don't know the exact cause of MDS. These cases are called de novo
MDS. We do know that certain lifestyle factors are linked to MDS. MDS cannot be
passed down through the genes from parent to child and it cannot be passed through
germs from person to person.

You are more likely to develop MDS if you have:

Been a smoker

Been heavily exposed to certain chemicals, such as benzene

Had chemotherapy or radiation treatments.
These can cause treatment-related or secondary MDS.

Treatment-related MDS is often severe and can be more difficult to treat than de
novo MDS. Approximately 90% of people with myelodysplastic syndrome have what is
called, “de novo” MDS, meaning it arises without any known cause. A minority of
people with MDS have a bone marrow condition that came about as a result of therapies
for other cancers – what we call therapy-related

Treatment of MDS

It depends on the type of MDS and its severity .It could be

Blood transfusion.

Mild Chemotherapy.

Growth factors to stimulate the bone marrow.

In young patients, Bone marrow transplant is an option.

Chemotherapy FACTS

What is chemotherapy and how does it work?

Chemotherapy is the use of medicines or drugs to treat a disease, such as cancer.
Many times this treatment is just called chemo.

How does chemo work to treat cancer?

Surgery helps to remove the cancer. However, surgery can not remove all the disease
and if even a single cancer cell is left in the body, it can grow back. Also if
cancer has spread, then surgery does not work. Similarly radiation therapy kills,
or damages the cancer cells in a certain area .It does not work on whole body.

Chemotherapy can work throughout the whole body. It works to kill cancer where it
started and Chemo also kills cancer cells that have metastasized (meh-TAS-tuh-sized)
or spread to parts of the body far away from the primary (original) tumor.

How is it decided which cancer drug is used in which cancer?

More than 100 chemo drugs are used in many combinations. A single chemo drug can
be used to treat cancer, but often multiple drugs are used in a certain order or
in certain combinations (called combination chemotherapy). Multiple drugs with different
actions can work together to kill more cancer cells. This can also reduce the chance
that the cancer may become resistant to any one chemo drug.

These drugs have been tested in clinical experiments( clinical trials) and proven
to work .One drug may work in one cancer and not work in other cancer.

What Dose of chemo will be given to me?

It depends on the type of chemo, type of cancer and patients condition. It is very
important to use chemo medications in proper dose and schedule. Otherwise its effectiveness
is reduced.

Dose is calculated based on your height, weight and other body functions.

What is the goal of chemo?

Depending on the type of cancer, its stage (how far it has spread), and where you
are in the treatment process, chemo can be used to:

Cure the cancer.

Keep the cancer from spreading.

Slow the cancer’s growth.

Kill cancer cells that may have spread to other parts of the body.

Relieve symptoms caused by cancer.

Contact Us

Feel free to get in touch with us and we will be back in contact with you shortly.

Doctors Hospital Cancer Center

We treat patients at new Purpose built Cancer Center at Doctors Hospital inaugurated
in November 2014. This is state of the art cancer center with 14 infusion suites
for chemotherapy. Each suite is private, safe and comfortable. In each suite/Cabin
there is comfortable Bed or Special Chemotherapy Administration chair, Television,
and all medical equipment required for safe and comfortable administration of chemotherapy.

Our staff is fully trained in preparation and administration of chemotherapy. We
have chemotherapy trained nurses and pharmacist.

Our chemotherapy is prepared in specially built biologically safe drug preparation
hood as per international safety standards. This not only ensures that the patients
receive chemo in safe manner but also that they receive the exact amount of chemotherapy
as per international Cancer treatment guidelines like NCCN / ESMO GUIDELINES.

Our chemotherapy nurses are certified and trained to administer Chemotherapy. Special
precautions are taken to administer chemotherapy. All patients are given special
medications before chemotherapy so that chemotherapy side effects are minimized.